Correlation between long-term care nursing competences and willingness to serve in Home Medical Care Integration Program among home health care nurses in Taiwan

Abstract

SUMMARY The world is facing demographic changes with a rapidly aging population The National Health Insurance announced the “Home Medical care Integration Pilot Program” in 2015 and the home care nurse is an indispensable specialized role of this program Home care nurses’ long-term care nursing competence and willingness to participate in policy is worth further investigation A cross-sectional correlation study was conducted total 123 subjects The long-term care competence of the subjects was assessed in three domains with the scores of "long-term care profession ethical and legal" (M=3 28± 56) "long-term care provision and management" (M=3 18± 54) and "long-term care role professional development" (M=3 12± 52) The willingness to serve the subjects’ “subjective norm” scored the highest (M=3 01± 60) followed by "intention" (M=2 85± 65) "attitude" (M=2 85± 60) and "perceived behavior control" (M=2 54± 70) There were positive correlations between the three dimensions of long-term care nursing competence and the four dimensions of participation willingness with only no significant finding in "perceived behavior control" dimension (r= 15 p= 105) Results of the hierarchical regression analysis shown significant predicting factors of attitude perceived behavior control and intention which explained 18 8% 16 1% and 14 2% of the total variances It is expected that the results of this study will provide nursing schools and nursing institutions reference of the home care nurse’s competence and on-the-job training in the future As well as the government’s health policy process to understand the willingness and difficulties of home care nurses to participate and as a reference for future revision of this policy INTRODUCTION Taiwan became an aging society in 1993 officially entered an aging society in 2018 and is estimated that it will become a super-aged society in 2026 With the increasing demand for long-term care the proportion of hospitalizations and expenditures for the elderly has risen highlighting the increasing burden on the working population Due to the difficulties for disabled and demented people to move around for seeking medical treatment the new health care service model to improve accessibility reduce the hospitalization days and needless hospitalizations and provide holistic care is needed The purpose of this study was 1 To examine the nurses’demographic characteristics long-term care nursing competence and willingness to serve in health policy of home care nurse in Taiwan 2 To explore the relationships among nurses’ demographics and their long-term care nursing competence and willingness to serve 3 To analyze the correlation between demographic data and long-term care nursing competence and willingness to serve and to identify the predictors of willingness to serve METHODS The cross-sectional correlation study was conducted and the cluster random sampling method was adopted in four areas of North Central South East and Offshore islands of Taiwan A total of 31 home care nursing units were sampled and 130 questionnaires were mailed with 123 valid ones retrieved The research instruments included as follows 1 The willingness to service and demographic data were developed based on "Theory of Planned Behavior" model (Schifter & Ajzen 1985) 2 The long term care nursing competence scale developed by Hsieh (2014) SPSS 22 0 software was used for data analysis mean standard deviation and percentage were used for the descriptive statistics; inferential statistics were analyzed using independent t test Mann-Whitney U test one-way ANOVA Pearson's correlation and Hierarchical Linear Model RESULTS AND DISCUSSION Among 123 subjects 99 2% were women 87% married with an average of 41 25 years old distributed from 38 2% of the hospital based 35 8% of the free stand and 26% of the primary health station based home nursing agencies Their average working experience was 18 1 years and specialized in home nursing was 7 5 years The majority of the subjects were registered nurses (70 7%) with highest education level of university graduates (52 8%) and only 7 3% were still pursing further education Most of them obtained N2 in clinical ladder (25 2%) and most had completed the long-term professional training certified by the Ministry of Health and Welfare (Level I 100% Level II 81 3% and Level III 55 3%) There were 88 6% of the agencies provided education and training channel and 87% had joined the home medical care integrated program In terms of willingness to serve the subjects’ “subjective norm” scored the highest (M=3 01± 60) followed by "intention" (M=2 85± 65) "attitude" (M=2 85± 60) and "perceived behavior control" (M=2 54± 70) There were statistically significant relationships found between demographic variables and long-term care nursing competence Those completed long -term care training had better "long-term care profession ethical and legal" in the long-term care nursing competence than their counterparts (t= -2 36 p= 020) "The nurse serve in the free stand facility" have statistically significant –higher "long-term care profession ethical and legal" (F= 3 15 p= 046) "provision and management of long-term care" (F= 3 19 p= 045) and the overall long-term care and nursing competence (F=3 11 p= 048) than those in hospital or primary health care center based agencies Significant relationship between demographic variables and willingness were found in level of clinical ladder and "attitude" (t = 3 07 p = 003) Those who hadn’t completed long-term care training showed a significant higher score in the "perceived behavior control" (t=2 04 p= 043); agencies provided on-job training had showeda better "intention" to serve than others (t=2 04 p= 035) There were significant differences in educational level (t= 17 p= 040) and advance training (t=2 49 p= 014) with "overall willingness" There were six factors predicting willingness in common included long-term care role professional development and long-term care provision and management in the long-term care nursing competence type of home nursing agencies participating at the advanced training and score of long-term care nursing competence in long-term care profession ethical and legal CONCLUSION In response to the demand for aging care Taiwan has promoted the “home medical care integration plan” since 2015 for whom home care nurse are indispensable for this project It is found that only 7 3% of the home care nurses were pursuing further education and 11 4% of the agencies did not provide education training channels and 46 3% did not continuously participate in the professional competency advancement system In term of perceived long-term care nursing competence we found that "familiar with laws and regulations related to long-term care" "effective integration of relevant research and empirical knowledge in long-term care nursing practice" " the spiritual demand of in-depth assessment " and "psychological and spiritual needs of dying patient" "promote long-term care nursing in international visibility" scored the lowest It was found that "if the home care is required to provide 24-hour telephone response or night shift service in the future" had the lowest average score in willingness Based on the above results it is recommended that in the future we should pay attention to the transparency of the education and training channels for home care nurse and to establish an in-service training and motivation for long-term care advancement system In terms of recommendation for education and research it is suggested to strengthen laws and regulations psychological and spiritual assessment and care for the home patients apply empirical knowledge to home-based care and integrate the results of research and publication for further education Finally assessment for nurses’ resources and competences before policy implementation should be recommended If 24-hour home care service is required in the future the relevant staffing arrangement should also be considered for the needs of home care nurses

Date of Award	2019
Original language	English
Supervisor	Ching-Min Chen (Supervisor)